| Last Action | 03/29/22: signed by Governor (Acts Ch. 48) |
|---|---|
| Title | AN ACT relating to health care trade practices. |
| Bill Documents |
Acts Chapter 48
Current/Final Introduced |
| Fiscal Impact Statement | Health Mandate |
| Bill Request Number | 1542 |
| Sponsors | D. Lewis, B. Reed, A. Bowling, K. Bratcher, P. Flannery, N. Kirk-McCormick, M. Lockett, C. Massey, S. McPherson, M. Pollock, S. Riley, S. Santoro, S. Sheldon, T. Smith, R. Webber, S. Westrom |
| Summary of Original Version | Create new sections of Subtitle 17C of KRS Chapter 304 to define terms; permit third-party access to provider network contracts if certain conditions are met; prohibit a dental carrier from canceling or otherwise ending a contractual relationship with a provider that opts out of third-party access; require a dental carrier to accept a qualified provider regardless of whether the provider opts out of third-party access; provide that a provider shall not be bound by third-party access granted in violation of the relevant provisions; establish exceptions to the third-party access provisions; allow a dental benefit plan to deny a claim for procedures included in a prior authorization when certain conditions are met; establish requirements for payments from the dental benefit plan to the dentist; require an insurer of a dental benefit plan to honor an assignment of benefits and make payments directly to the dentist or professional dental service corporation when certain conditions are met; permit a dentist or professional dental service corporation with a valid assignment of benefits to bill the insurer and notify the insurer of the assignment; require the dentist or professional dental service organization to provide the assignment of benefits to the insurer upon request; allow an assignment of benefits to be revoked when certain conditions are met; require the insurer of a dental benefit plan to send a revocation to the dentist or professional dental service corporation; establish the effective date of a revocation; require a dentist or professional dental service corporation to reimburse an insured under certain circumstances; prohibit provisions relating to third-party access, prior authorization, and assignment of benefits from being waived by contract; create a new section of Subtitle 17A of KRS Chapter 304 to require an insurer and its health insurance plans to comply with the provisions relating to third-party access, prior authorization, and assignment of benefits; amend KRS 304.17C-085 to define terms; prohibit a provider from charging more than the provider's rate for noncovered services under a limited health service benefit plan; prohibit the amount of a contractual discount for covered services from resulting in a fee less than the limited health service benefit plan would pay but for certain contractual limitations; require reimbursement by a limited health service benefit plan to be reasonable and prohibit nominal reimbursement in order to claim services are covered; amend KRS 304.17A-611 to require retrospective denials of dental services to comply with the new section on prior authorization; amend KRS 222.422 to conform; permit the commissioner of insurance to promulgate regulations. |
| Index Headings of Original Version |
Health and Medical Services - Dental services, health insurance, requirements Health and Medical Services - Dental services, provider, requirements Health and Medical Services - Limited health service benefit plans, requirements, provider charges for services Insurance, Health - Dental services, requirements Insurance, Health - Limited health service benefit plans, requirements Administrative Regulations and Proceedings - Commissioner of insurance, dental services, requirements Health Benefit Mandate - Dental services, requirements Physicians and Practitioners - Changes, limited health services, requirements |
| Jump to Proposed Amendments |
House Committee Substitute 1 House Floor Amendment 1 |
| Votes | Vote History |
| 01/25/22 |
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| 02/22/22 |
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| 02/23/22 |
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| 02/24/22 |
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| 02/25/22 |
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| 03/07/22 |
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| 03/15/22 |
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| 03/16/22 |
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| 03/17/22 |
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| 03/22/22 |
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| 03/23/22 |
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| 03/24/22 |
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| 03/29/22 |
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| Amendment | House Committee Substitute 1 |
|---|---|
| Summary | Retain original provisions, except delete various notice and disclosure requirements for contracting entities; require contracting entities to update list of third parties on Web site every 60 days; create exceptions to provider discount provisions; amend provision allowing a claim to be denied after prior authorization has been granted; delete section on assignment of benefits; delete section requiring insurers and health insurance plans to comply with requirements for dental carriers and dental benefit plans; delete provision amending KRS 222.422. |
| Index Headings |
Health and Medical Services - Limited health service benefit plans, requirements Health and Medical Services - Limited health services, provider, charges, requirements Insurance, Health - Dental services, requirements Insurance, Health - Limited health service benefit plans, requirements Physicians and Practitioners - Charges, limited health services, requirements Administrative Regulations and Proceedings - Commissioner, Department of Insurance, dental services, requirements Health and Medical Services - Dental services, health insurance, requirements |
| Amendment | House Floor Amendment 1 |
|---|---|
| Sponsor | D. Lewis |
| Summary | Make technical changes. |
| Index Headings |
Technical Corrections - HB 370/HCS1 Insurance, Health - Dental services, requirements Health and Medical Services - Dental services, requirements |
Last updated: 2/8/2023 2:57 PM (EST)